[Pain assessment in Down Syndrome patients: a narrative review of the literature]

OBJECTIVE

The paper provides a description of available measurement tools which are able to adequately assess acute chronic pain in Down Syndrome (DS) patients, regardless of their age and cognitive impairment.

METHODS

Papers referring to DS patients were sought using different databases, such as PubMed, CINAHL, Scopus, Web of Science (ISI) and Cochrane, with no limit of time and published up to October 2017. All validated tools applicable to DS patients were included in the search, which consisted of papers published both in English and Italian. Irrelevant studies not pertaining to this specific query, grey literature publications, Commentaries, Letters and Editorials were excluded.

RESULTS

Six pain assessment tools were obtained, based on the observations of caregivers and healthcare's practitioners and on the interpretation of behavioral cues of patients unable to self-report. The identified tools were: the Non-communicating Children's Pain Checklist-Revised (NCCPC-R), the Pediatric Pain Profile (PPP), the Revised Face, Legs, Activity, Cry and Consolability Scale (r- FLACC), the Individualized Numeric Rating Scale (INRS) and the COMFORT-Behavior Scale (COMFORT-B), all applicable to patients affected by chromosomic diseases. The COMFORT- Behavior Scale (COMFORT-B) could be used only in DS infants (0-3 years) undergoing mechanic ventilation. Four of the six tools have also been validated in Italian.

CONCLUSIONS

To date national and international research studies have not been able to adequately respond to the needs of DS patients who are not be able to clearly express the level of pain they may be experiencing. Only one assessment tool turned out to be suitable for measuring pain intensity in the pediatric population undergoing mechanic ventilation. (COMORT-B), although this latter could not be used for assessing pain intensity in other DS populations. This means that there is the urgent need to carry out further validation studies so that a wider range of pain assessment tools may be used for people with Down's syndrome.

Managing care errors in the wards

Purpose

The importance of an error management culture (EMC) that integrates error prevention with error management after errors occur has been highlighted in the existing literature. However, few empirical studies currently support the relationship between EMC and errors, while the factors that affect EMC remain underexplored. Drawing on the conceptualisation of organisational cultures, the purpose of this paper is to verify the contribution of authentic leadership in steering EMC, thereby leading to reduced errors.

Design/methodology/approach

The authors conducted a cross-sectional survey study. The sample included 280 nurses.

Findings

Results of a full structural equation model supported the hypothesised model, showing that authentic leadership is positively associated with EMC, which in turn is negatively associated with the frequency of errors.

Practical implications

These results provide initial evidence for the role of authentic leadership in enhancing EMC and consequently, fostering error reduction in the workplace. The tested model suggests that the adoption of an authentic style can promote policies and practices to proactively manage errors, paving the way to error reduction in the workplace.

Originality/value

This study was one of the first to investigate the relationship between authentic leadership, error culture and errors. Further, it contributes to the existing literature by demonstrating both the importance of cultural orientation in protecting the organisation from error occurrence and the key role of authentic leaders in creating an environment for EMC development, thus permitting the organisation to learn from errors and reduce their negative consequences.

Vessel health and preservation: An integrative review

AIMS AND OBJECTIVES

To describe and synthesise current knowledge on the maintenance and preservation of vessels in patients who need the placement of a vascular access device.

INTRODUCTION

To administer drugs, blood or intravenous fluids, nurses or doctors insert a peripheral vascular access device on the arm using the traditional approach. This approach implies that devices are blindly inserted until flow is satisfactory and all possible sites have been exhausted. A proactive approach would ensure at the outset that the best device is used for each patient, eliminating repeated attempts at cannulation.

DESIGN

An integrative review was conducted using data recorded until July 2017. Searches were conducted in PubMed, Cochrane Library, CINAHL and Scopus.

REVIEW METHOD

A modified version of Cooper's five-stage method and the PRISMA guidelines were used to perform the integrative review.

RESULTS

Nine papers were included in this review. The patients were active participants in a proactive approach to vessel health and preservation. The involvement of each healthcare professional in vessel health and preservation improves outcomes and expands the use of a proactive approach to vascular device management. Because nurses are directly involved in the use of such devices and support patients during the decision-making process, they should take the lead in the use of the proactive approach.

CONCLUSION

Despite the many documented advantages of the proactive approach to preserving vessels in many settings and healthcare systems, it has not been widely tested. Future research is needed to guarantee high-quality vessel health and preservation care, thus contributing to the development and dissemination of the proactive approach.

RELEVANCE TO CLINICAL PRACTICE

The proactive approach preserves vessels for future needs, improves the delivery of the treatment plan and reduces length of stay, costs, risk of infection, complications and pain perceived by patients. This approach also ensures better use of nurses' time and vascular access device material.

[Influenza prevention in health-care workers: enhancement of the influenza vaccination campaign at Policlinico Tor Vergata in Rome (Italy) during the 2017/2018 epidemic season]

Given the very low influenza vaccination coverage averaging 4% among health-care workers at Policlinico Tor Vergata during the previous epidemic seasons, it was decided to implement a series of interventions to promote influenza vaccination compliance in the current (2017/2018) season. The total number of vaccinated health-care workers at the end of the current season was 364, resulting in a vaccination coverage of approximately 12%. The increase took place in all professional groups, with a coverage of 25% among permanent MDs, 9% among Medical Residents, 3% among nurses and 8% among technicians. The influenza vaccination coverage of 12%, although very low compared to the minimum target of 75%, is broadly in line with the values reported by other hospitals in Italy.

[Construction and validation of a tool for the evaluation of environmental risks and limitations to the manual handling of loads: cross-sectional study]

INTRODUCTION

The manual handling of loads has a strong impact on many types of work. All health professionals, due to their job, are subjected to a high risk of disease from the manual handling of loads.

TARGET

The purpose of our work has been therefore the construction and the validation of a specific tool for the evaluation of both environmental risks and individual limitations of the manual handling of loads / patients.

MATERIALS AND METHODS

The questionnaire we created is composed of two main sections: the first section includes the registry card of the operator personal data while the second section, consisting of eleven items it is further organized into two sections/parts. The first part consists of four items about environmental risk factors, while the second part consists of seven items about generic limitations and the assessment of pain from manual handling of loads.

RESULTS

The operators'health nurses, including those ones with a coordination responsibility, that are available in the structure are 704 while the response rate to the questionnaire was of 93.18%. The test-retest showed optimal values of the intra-class correlation coefficient (0.843) so demonstrating the absence of measurement errors in the two administrations. The values related to the internal consistency of the two sections of the questionnaire were greater than 0.80that also demonstrated the internal stability of the questionnaire.

CONCLUSIONS

The tool we described therefore is to be intended as a means of assessment for environmental risks, restrictions on movement of loads and pain associated with the task.

Modified Moral Distress Scale (MDS-11): Validation Study Among Italian Nurses

BACKGROUND

Moral distress (MD) has significant implications on individual and organizational health. However there is a lack of an instrument to assess it among Italian nurses.

AIM

The main aim of this study was to validate a brief instrument to assess MD, developed from the Corley's Moral Distress Scale (MDS).

METHOD

The modified MDS scale was subjected to content and cultural validity. The scale was administered to 347 nurses. Psychometric analysis were performed to assess construct validity.

RESULTS

The scale consists of 11 items, investigating MD in nursing practice in different clinical settings. The dimensionality of the scale was investigated through exploratory factor analysis (EFA), which showed a two-dimensional structure labeled futility and potential damage. The futility refers to feelings of powerlessness and ineffectiveness in some clinical situations; the potential damage dimension captures feelings of powerlessness when nurses are forced to tolerate or perform perceived abusive clinical proceedings. Nurses who experienced higher MD, were more lilely to experience burnout.

CONCLUSIONS

The modified MDS showed good psychometric properties, and it is valid and reliable for assessing moral distress among Italian nurses. Hence, the modified MDS allows to monitor the distress experienced by nurses and it is an important contribution to the scientific community and all those dealing with well-being of health workers.

Development and validation of Emotional Labour in Nursing Scale in Italy

BACKGROUND

Emotional demands may be a significant risk factor for wellbeing in healthcare professionals. Nurses have been considered the most exposed to emotional burden known as emotional labour. Scholars define it as the process by which nurses sometimes hide/fake the real emotion or struggle to display the appropriate emotion to meet the emotional work requirements. Emotional labour can result in physical, psychological and behavioural disorders. A specific tool to measure it among nurses is still missing.

OBJECTIVES

This study aims to develop and validate an emotional labour scale for nurses.

METHODS

The design process consisted of three different phases. In the first one, 24 items have been selected from different tools. The second consisted of the assessment of the face and content validity. In the third phase, the Emotional labour scale has been psychometrically evaluated through a cross validation approach, including both exploratory factor analysis performed on a sample of 205 Italian nurses, with the final selection of an 11- items tool, and confirmatory factor analysis.

RESULTS

Emotional labour is acted through surface acting, compliance and restraint. The Emotional Labour Nursing scale showed good psychometric properties and was found to be valid and reliable for assessing emotional labour among nurses. The association between emotional labour and burnout was investigated.

CONCLUSIONS

The Emotional Labour scale may foster a fuller understanding of the consequences of emotional labour. Since emotional demands and emotional labour are not included in the most common psychosocial risk assessment tools currently available, our results point out to their role in work stress prevention.

[The burden of informal caregivers of multiple sclerosis patients: a pilot study]

AIM

The main objective of the study was to measure caregiver burden among informal caregivers assisting people with multiple sclerosis (MS).

BACKGROUND

Thirty percent of people with multiple sclerosis require some form of home assistance and 80% of such care is provided by informal caregivers. The quality of life of informal caregivers of patients with multiple sclerosis decreases with increasing physical and depressive symptoms of their loved ones. This can have effects on stress levels, physical and mental health, quality of life, and mortality of informal caregivers.

DESIGN

A descriptive correlational study was performed in a sample of informal caregivers of MS patients.

METHODS

The study enrolled 41 informal caregivers of MS patients at a regional reference center in Rome, Italy. Data collection took place in the period between May and September 2016. A paper questionnaire was used, comprising a socio-demographic section and a "Caregiver Burden Inventory" section.

RESULTS

The subjective burden perceived by informal caregivers of patients with MS is moderate. Socio-demographic characteristics were not found to influence burden of caregivers.

CONCLUSIONS

It is important for nursing professionals to consider and evaluate the burden of informal caregivers of MS patients as they are valuable allies in the management of these patients.

Mental and physical well-being in oncology-hematology-unit personnel

Health care workers (HCWs) in university hematology units (UHUs) face high job demand that can have adverse health effects. This cross-sectional study investigated the relationship between some job stressors and health-related quality of life among HCWs of 3 UHUs in Rome. Work-related stress was measured with the Demand-Control Questionnaire; health-related functioning with the mental component score (MCS) and physical component score (PCS) of the Short Form 12 Survey; positivity with the Positivity Scale. Data of 201 respondents were analyzed. Job demand was inversely associated with MCS (p = .05) and PCS (p = .049); job control was directly associated with PCS (p < .001) and MCS (p = .024). A high positivity scale score and high decision latitude score predicted high MCS and PCS. High job demand score predicted low MCS and PCS scores. Reduced job stressors and enhanced positive attitudes can improve HCWs' health-related quality of life.

Violating organizational and social norms in the workplace: a correlational study in the nursing context

OBJECTIVES

The aim of this study was to examine, in a sample of nurses, the relationships between the organizational context variables (i.e., workload, interpersonal conflicts, organizational constraints), the burnout, the moral disengagement, and the counterproductive work behaviors (CWB), within their clinical work settings.

METHODS

A descriptive, correlational study was conducted in a sample of 347 nurses working in different clinical settings in a big university hospital in Central Italy. A self-report questionnaire was used for data collection, using several scales to assess different variables related to the organisational context, the burnout, the interpersonal strain, the moral disengagement, and the CWB.

RESULTS

The clinical context was found to influence nurses' organizational wellbeing, which in turn was found to foster CWB. Nurses working in outpatients settings and in day hospitals were those who reported the lowest CWB, in comparison with nurses working in the Emergency Department and in the General Medicine Units.

CONCLUSIONS

Findings of this study are important for nursing professional chiefs and for any professional involved in the promotion of workers' wellbeing. Our study findings highlight how the clinical work setting and the organizational context variables can lead to CWB. Researchers and managers should keep these aspects in high consideration due to their influence on the quality of the care delivered.

Towards an integrated model of nursing competence: an overview of the literature reviews and concept analysis

INTRODUCTION

Competence is considered a fundamental element when measuring a nurse's or student's ability to provide nursing care, but there is no consensus on what competence really is. This paper aims to review the existing meanings and models of nursing competence.

METHOD

The overview of literature reviews and concept analysis was performed through a search on Pubmed, Cinahl and PsychINFO from January 2005 to September 2014. It included key words, such as: Competence Model; Professional Competence; Nursing Competence; Competency Model; Professional Competency; Nursing Competency.

RESULT

A total of 14 papers were found, coming from educational or clinical nursing field. It was possible to identify some common themes: description of competence determinants; confu- sion around the competence concept; lack in competence evaluation; lack when competence have to be operationalized.

CONCLUSION

The overview results, enriched by the literature coming out from the organiza- tional studies, build the conceptual basis of an integrated model of nursing competence. More empirical research is needed to test the theoretical assumptions.

[The ethical leadership of the nursing ward managers as a key determinant of nurses' organisational behaviours in the healthcare settings]

AIM

The main aim of this study is to examine the influence of the coordinator's ethical leadership on nurses' emotions (i.e., positive and negative) and work behaviours.

METHOD

A questionnaire was administered in paper format, including well-validated scales reported in literature, to a sample of 347 nurses working in a university hospital. A structural equation model has been tested after examining Pearson's correlations among study variables.

RESULTS

The coordinator's ethical leadership is strongly related to the implementation of nurses' organisational citizenship behaviour and counterproductive work behaviour, which are influenced by their emotions. Positive emotions fully mediate the relationship between ethical leadership and organisational citizenship behaviour, while negative emotions partially mediate the relationship between ethical leadership and counterproductive work behaviour.

CONCLUSIONS

Ethical leadership acts on nurses' organisational behaviour, as described in the modelling process. The nurses' organisational behaviour is crucial to the outcome of the health care service. Therefore, the ethical leadership indirectly affects the quality of the care and the cure offered to the patients.

[Wound Care Management: impact on outcomes of nursing care]

AIM

To evaluate wound care management in Rome's Hospital.

METHOD

Observational study, divided into phases, through the analysis of 301 nursing records of patients either admitted to the hospital with ulcer pressure at the admission or grown later. Among the nursing records, 151 have been analyzed directly in the wards and 150 are referred to the triennium 2010-2012 and have been traced in a computerized version.

RESULTS

The nursing records concerning the ulcer pressure is completed in 4% average. The Push Tool and Braden scale are respectively present in 6% and 86% of the nursing records analyzed. The treatment are correct in the 80% of the cases. The clinic outcome is stable in 68% of the cases and in the 13% is registered an enhancement.

CONCLUSIONS

The study underlined an increase of the nursing documentation, although not completed caused by the absence of the Push Tool scale. It has been registered an enhancement of the clinic outcome in the five years and a better pertinence in the treatment of the ulcers pressure. However is evident the necessity of increasing education courses on the ulcers pressure.

Nurse moral disengagement

Background:

Ethics is a founding component of the nursing profession; however, nurses sometimes find it difficult to constantly adhere to the required ethical standards. There is limited knowledge about the factors that cause a committed nurse to violate standards; moral disengagement, originally developed by Bandura, is an essential variable to consider.

Research objectives:

This study aimed at developing and validating a nursing moral disengagement scale and investigated how moral disengagement is associated with counterproductive and citizenship behaviour at work.

Research design:

The research comprised a qualitative study and a quantitative study, combining a cross-validation approach and a structural equation model.

Participants and research context:

A total of 60 Italian nurses (63% female) involved in clinical work and enrolled as students in a postgraduate master’s programme took part in the qualitative study. In 2012, the researchers recruited 434 nurses (76% female) from different Italian hospitals using a convenience sampling method to take part in the quantitative study.

Ethical considerations:

All the organisations involved and the university gave ethical approval; all respondents participated on a voluntary basis and did not receive any form of compensation.

Findings:

The nursing moral disengagement scale comprised a total of 22 items. Results attested the mono-dimensionality of the scale and its good psychometric properties. In addition, results highlighted a significant association between moral disengagement and both counterproductive and citizenship behaviours.

Discussion:

Results showed that nurses sometimes resort to moral disengagement in their daily practice, bypassing moral and ethical codes that would normally prevent them from enacting behaviours that violate their norms and protocols.

Conclusion:

The nursing moral disengagement scale can complement personnel monitoring and assessment procedures already in place and provide additional information to nursing management for designing interventions aimed at increasing compliance with ethical codes by improving the quality of the nurses’ work environment.

Development and validation of the Nursing Profession Self-Efficacy Scale

AIM

This study describes the development and validation of the Nursing Profession Self-Efficacy Scale.

BACKGROUND

Self-efficacy can be useful in predicting performance, job satisfaction or well-being. In the nursing field, there is a shortage of studies on self-efficacy with regard to nurses' global confidence in coping ability across a range of everyday, challenging work situations.

METHODS

To define the theoretical framework of nursing professional self-efficacy, two focus groups and a literature review were performed. An empirical study was then conducted to test validity and reliability. Face and content validity, construct validity, concurrent validity, internal consistency and test-retest reliability were examined. The content validity index was evaluated by 12 experts who suggested deleting 11 redundant items. The final developed tool was tested for construct analysis using a cross-validation approach, randomly splitting the overall sample of 917 nurses in two sub-groups.

FINDINGS

The construct validity indicated two dimensions. The face and content validity were adequate. Test-retest reliability displayed a good stability, and internal consistency (Cronbach's α) was acceptable. Moreover, concurrent validity using the Generalized Self-Efficacy Scale was in line with the theoretical framework.

CONCLUSION

The scale showed evidence of validity and reliability. The major limitation is the strong influence of the Italian context in the tool development.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

The Nursing Profession Self-Efficacy Scale could be a fruitful tool that facilitates the application of theories (i.e. social-cognitive theory) in the nursing field and even development of interventions. Furthermore, a measurement of self-efficacy could be used to predict nursing clinical performance.

[Nurses and Organizational Citizenship Behavior: contribution to the Italian validation of the Podsakoff et al. scale]

BACKGROUND

Workers engaging in Organizational Citizenship Behaviour (OCB) can benefit colleagues, organization and stakeholders. Such behavior is vital to the efficacy of health care organizations as they can have a positive effect on the quality of care and users' satisfaction. Therefore, it is important to assess such behaviour with a valid and reliable instrument.

OBJECTIVES

The purpose of this study was to test, from a confirmatory perspective, the dimensionality of the Italian version of the Podsakoff et al. OCB scale in a large sample of nurses, and at the same time to evaluate the differences in nurses' OCB considering socio-demographic and job characteristics.

METHODS

The study included 886 nurses from different health organizations in Italy. The psychometric characteristics of the Italian OCB scale were tested through confirmatory factor analysis (CFA). The differences in nurses' OCB, according to several socio-demographic and job characteristics, were evaluated through a series of correlations and analysis of variance.

RESULTS

The CFA of the Italian OCB scale confirmed the hypothesized factor structure, consisting of three dimensions: altruism, civic virtue and conscientiousness. Nurses' gender and professional training were positively correlated with OCB, while the amount of extra work was negatively correlated. In regard to clinical work settings, palliative care nurses engaged in OCB more than nurses working in other areas.

CONCLUSIONS

The Italian OCB scale is a valid and reliable instrument. Its use can support all individuals involved in the promotion of workers' organizational well-being in implementing processes aimed at fostering nurses' OCB.

[Structural empowerment and job satisfaction among nurses coordinators: a pilot study]

INTRODUCTION

In literature, the structural empowerment and the job satisfaction have been studied in many different work settings but more need to be done in the setting of Head Nurses.

OBJECTIVE

The goal of the study is to evaluate the structural empowerment level of head nurses and if it impacts on the job satisfaction.

METHODS

A cross sectional design study was used. We enrolled 125 head nurses from three different hospitals of Rome. To collect the data we used a questionnaire that included both a part of the collection of sociopersonal data and the two scales (job satisfaction and structural empowerment). We used the SPSS19.0 statistical Software for data analysis to detect significant results.

RESULTS

Head Nurse declared to be not enough satisfied at work (mean=3.43) and their structural empowerment level resulted moderate (mean=3.16). The structural empowerment of head nurses impacts their job satisfaction especially concerning opportunities for social and professional interactions, praises, awards, audit and responsibilities.

CONCLUSIONS

Results underline structural empowerment relevance in head nurses job satisfaction. Healthcare organizations need to address job satisfaction to improve quality of care and more specifically that of head nurses since they directly impact on nurses job satisfaction.

[Counterproductive behaviors and moral disengagement of nurses as potential consequences of stress-related work: validity and reliability of measurement scales]

BACKGROUND

Several studies, but no one in the nursing, have shown that work stress can facilitate the adoption of specific behaviors that the literature identifies as Counterproductive Work Behaviors (CWB). Individuals, however, not giving up to their moral principles, may transgress social, organizational, moral and ethical norms, through the adoption of moral disengagement (MD).

OBJECTIVES

The purpose of this study is to validate two specific scales of deviant behaviors and MD in nursing: the Nursing Counterproductive Work Behaviours Scale (Nursing CWBS) and Nursing Moral Disengagement Scale (Nursing MDS).

METHOD

460 nurses participated in the study. After the adaptation of the Counterproductive Work Behavior Checklist by Spector and Fox to Nursing context (Nursing CWBS) and the ex novo development of the Nursing MDS, the psychometric properties of the two scales were tested. Also, the two scales were correlated.

RESULTS

Through a cross-validation approach and based on the results of exploratory factor analysis (EFA) and confirmatory factor analysis (CFA), we have shown that the scales have good psychometric properties. Furthermore, the results, attest that the nurse with high levels of MD implements more CWB in the workplace.

CONCLUSIONS

The Nursing CWBS and Nursing MDS represent a valid starting point for the study of such phenomena in this specific context where stress among nursing staff is sometimes of considerable extent, especially in specific contexts of clinical care.

Nurse coordinator leadership and work environment conflicts: consequences for physical and work-related health of nursing staff

BACKGROUND

Research has amply demonstrated that positive leadership counters the onset of burnout and conflicting situations between colleagues that in turn create favourable conditions for a healthy organization and consequently for good quality of care.

OBJECTIVES

To investigate if more positive leadership is associated with lower levels of conflict in the work environment that in turn are associated with lower levels of burnout, psychosomatic disorders and negative indicators of work environment (feeling not being adequately appreciated, lack of clarity about tasks and roles, gossip, resentment towards the organization), and with higher levels of work satisfaction.

METHOD

Five scales of QISO (Nursing Organizational Health Questionnaire) and the Maslach Inventory (Burnout scale), were administered to a total of 192 nurses working in medical and surgical departments of two different Italian hospitals. The study design was cross-sectional. To test the hypothesis a structural equation model (SEM) was used.

RESULTS

The results of this study demonstrate the crucial role played by positive leadership of nursing coordinators that, directly and indirectly, promotes a healthy work environment with lower conflicts, burnout, and psychosomatic disorders among nurses and limits the presence of negative indicators in workplace.

CONCLUSION

This study demonstrates the key role of the nursing coordinator in creating a healthy work environment that contributes to physical and work-related health of the nursing staff.

[Decreasing preoperative anxiety by music: experimental study in a vascular surgery unit]

INTRODUCTION

Preoperative anxiety is common in patients undergoing surgical interventions. Several international studies have shown the positive effect of music before minor surgery and invasive procedures, but the effect of music before major surgery was not explored.

AIM

The aim of this study was to assess the effectiveness of music on anxiety in patients undergoing vascular surgery (aortic aneurism and thromboendarterectomy). Methods. Surgical patients were randomized to listening to music before surgery (music group) or to routine care. Anxiety was measured with the STAI-Y, administered three hours before surgery (Time 1) and before the induction of anesthesia (Time 2). After Time 1, only patients assigned to the music group listened to music.

RESULTS

The groups were comparable for the main characteristics. In the Music group (N 50) anxiety decreased after listening to music v the controls (N 50) (STAI-Y mean scores 52.2 and 31.1 respectively; p < 0.001). The differences between the two groups in the two measurements explained the 73% of the variance.

DISCUSSION

Listening to music is effective in decreasing anxiety in patients undergoing vascular surgery.

Organizational health and quality of life: survey among ambulance nurses in prehospital emergency care

BACKGROUND

The workplace plays a central role in causing stress and different kinds of syndromes and diseases. More generally, organizational procedures and practices could have an impact on nurses' quality of life. Although several studies have investigated this link, none of them considered nurses working in prehospital emergency care.

OBJECTIVES

To investigate the role of organizational health factors that affect the quality of life and psychosomatic complaints of ambulance nurses.

METHOD

Our sample included 411 ambulance nurses. Workers were administered two questionnaires to assess organizational health and quality of life. Descriptive and correlational analyses were used to test our assumptions.

CONCLUSION

Several organizational health dimensions provided an explanation for the complaints reported by nurses working in prehospital emergency care in terms of quality of life and psychosomatic disorders. The results allowed identification of possible interventions focusing on specific duties and organizational aspects that would improve the quality of nurses' health.

Positive and negative impact of caregiving to older adults: a structural equation model

Caregivers represent an important source of care for older adults. Many studies focused on the negative aspects of elder caregiving but few studies have analyzed also the positive effects. In addition, no studies have considered contemporarily the positive and the negative impact of caregiving to elderly people on the same people using a structural equation modeling. The purpose of this study was to examine the contribution of elder care recipient factors, caregiver factors and caregiving factors in determining the positive and negative impact of informal caregiving to older adults using a structural equation model. A cross-sectional design was used to study eighty caregivers of older people. Several instruments were used to measure elder care recipient factors (functionality, cognition, behavior); caregiver factors (socio-demographics, depression, stress, quality of life, and perceived health); caregiving factors (time from caregiving, time of care, social restriction, place of living, expenses, and living with the elder care recipient); and the positive and the negative impact of caregiving. Caregivers were 59.7 years old while elderly people were 84.0. Several factors were significantly correlated with the positive and negative impact of caregiving. However, when these factors were entered in a structural equation model, only female gender and social restriction predicted the negative impact, while caregiver's quality of life and caregiving expenses predicted both the positive and the negative impact. The results of this study suggest a new framework of caregiving to older adults where the outcomes depend more on caregiver and caregiving factors than on older person characteristics. More research is needed with a larger sample to test further the model outlined in this study.

[Operating theatre and medical ward nurses: two different ways of perceiving one's organizational health]

BACKGROUND

It is widely recognized that the working environment is crucial in the genesis of stress and other disorders that may affect nurses' health. The specific job context and the tasks performed by nurses in different clinical settings can be positive or negative predictors of organizational health.

OBJECTIVES

The aim of this study was to describe and compare organizational health among nurses working in operating theaters and medical wards.

METHODS

For the study 670 nurses from six university hospitals in Italy were asked to participate and a total of 542 nurses constituted the final sample. The Nursing Organizational Health Questionnaire was used to collect the data and was administered from January to March 2010. A descriptive/comparative design was used.

CONCLUSIONS

The results showed that nurses assigned to medical wards perceived their working environment as healthy and were significantly more satisfied and had less psychosomatic complaints than their colleagues working in operating theaters.